FINAL COACHING

MEDICAL SURGICAL NURSING III

Prepared by: Mr. Mike Chavez, RN, USRN
NOV 2024 Philippine Nurse Licensure Examination Review
NAME: DATE: SCORE: _____

“FIRST TAKER AKO, AT LAST TAKE KO NA ‘TO!

1.A client asks the nurse what PSA is. The nurse should reply A. Hydrate the skin each day with lanolin-based cream
that it stands for: B. Use a heating pad over the area if it becomes sore
A. prostate-specific antigen, which is used to screen for C. Do not wash off any skin markings
prostate cancer. D. Expose area to sunlight at least once each day
B. protein serum antigen, which is used to determine 9.A client is prescribed external radiation as part of his cancer
protein levels. treatment. Which of the following should be included in this
C. pneumococcal strep antigen, which is a bacteria that client's instructions?
causes pneumonia 1. Do not wash off the treatment marks.
D. Papanicolaou-specific antigen, which is used to screen 2. Use an electric razor to shave the treatment area.
for cervical cancer. 3. Wash the skin with soap and water.
2.A school nurse is planning to give a class on testicular self- 4. Avoid applying heat or cold to the area.
examination (TSE) at a local high school. The nurse plans to A. 3 and 4
include which of the following information on a written B. 1, 2, 4
handout to be given to the students? C. 1 and 2
A. Roll the testicle between the thumb and the forefinger D. All except 1
B. Perform the self- examination every other month 10.While a patient is receiving intravenous doxorubicin
C. Perform the self – examination after a cold shower hydrochloride, the nurse observes that there is swelling and
D. Expect the self- examination to be slightly painful pain at the IV site. The nurse should do all of the following
3.The nurse is speaking to a group of women about early except:
detection of breast cancer. The average age of the women in A. Stop the administration of the drug immediately
the group is 47. Following the American Cancer Society B. Notify the patient's physician
guidelines, the nurse should recommend that the women: C. Apply a cold compress to the site
A. perform breast self-examination annually D. Apply a warm compress to the site
B. have a mammogram annually 11.A client receives a sealed radiation implant to treat cervical
C. have a hormonal receptor assay annually cancer. When caring for this client, the nurse should:
D. have a physician conduct a clinical examination every A. consider the client’s urine, feces, and vomitus to be
2 years highly radioactive.
4.The nurse is teaching a client who suspects that she has a B. consider the client to be radioactive for 10 days after
lump in her breast. The nurse instructs the client that a implant removal
diagnosis of breast cancer is confirmed by: C. allow soiled lines to remain in the room until after the
A. breast self-examination client is discharged.
B. mammography D. maintain the client on complete bed rest with
C. fine needle aspiration bathroom privileges only.
D. chest X-ray 12.The client with breast cancer is prescribed Tamoxifen
5.A client is receiving chemotherapy to treat breast cancer. (Nolvadex) 20 mg. daily. The client states she does not like
Which assessment finding indicates a fluid and electrolyte taking medicine and asks the nurse if the Tamoxifen is really
imbalance induced by chemotherapy? worth taking. The nurse’s best response is which of the
A. Urine output of 400 ml in 8 hours following?
B. Serum potassium level of 3.6 mEq/L A. ”This drug is part of your chemotherapy program”
C. Blood pressure of 120/64 to 130/72 mm Hg B. “This drug has been found to decrease metastatic
D. dry oral mucous membranes and cracked lips breast cancer”
6.The nurse observes a staff member caring for a client with a C. “This drug will act as an estrogen in your breast
left unilateral mastectomy. The nurse would intervene if she tissue”
notices the staff member is D. “This drug will prevent hot flashes since you cannot
A. Advising client to restrict sodium intake take hormone replacement”
B. Taking the blood pressure in the left arm 13.A nurse is caring for a patient with prostate cancer, all but
C. Elevating her left arm above heart level one are signs of prostate cancer?
D. Compressing the drainage device A. Rectal pain
7.A client is to receive doxorubicin (Adriamycin) as part of a B. Urinary incontinence
chemotherapy protocol. The major life-threatening side effect C. Hematuria
of Adriamycin that the nurse should assess the client for is: D. Low back pain
A. Cardiotoxicity 14.A nurse is teaching at a health fair about the early warning
B. Pancytopenia signs of cancer. Which of the following are early warning signs?
C. Pulmonary fibrosis 1. A sore that does not heal
D. Ulcerative stomatitis 2. Change in bladder or bowel habits
8.A client is receiving external radiation. Teaching concerning 3. Family history
this treatment should include 4. Unusual discharge

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 5. Obvious change in nevus 23.A nurse is providing education in a community setting about
A. 1, 2, and 4 general measures to avoid excessive sun exposure. Which of
B. All except 3 the following recommendation is appropriate?
C. All except 5 A. Apply sunscreen only after going into the water.
D. All of the above B. Avoid peak exposure hours from 9am to 1pm.
15.For a client newly diagnosed with radiation-induced C. Wear loosely woven clothing for added ventilation.
thrombocytopenia, the nurse should include which intervention D. Apply sunscreen with a sun protection factor (SPF) of
in the plan of care? 15 or more before sun exposure.
A. Administering aspirin if the temperature exceeds 24.Risk factors for the development of breast cancer include:
102°F (38.8°C) A. Early menopause (before age 40).
B. Inspecting the skin of petechiae once every shift B. Early onset of menstruation.
C. Providing for frequent rest periods C. Having had more than two children.
D. Placing the client in strict isolation D. Breast-feeding.
16.A patient tells Nurse Hannah that he has heard that certain 25.A client is having chemotherapy. Which of the following
foods can increase the incidence of cancer. Nurse Hannah data is an early indication of extavasation?
suggests to the patient that the following food selections can A. Burning sensation above the IV site
increase the incidence of cancer except: B. Redness at the site
A. Tinapa and green beans C. Absence of backflow
B. Grilled liempo and grilled talong D. Slowing of the infusion rate
C. Steamed tilapia and steamed vegetable 26. The nurse should instruct the client under
D. Tocino, onions, and mixed vegetables chemotherapy with a platelet count of less than 150,000/mm3
17.Methotrexate is classified as an antimetabolite. When to avoid which of the following activities?
teaching the parents about how this medication works, the A. Ambulation
nurse includes the following information B. Valsalva maneuver
A. It lowers uric acid concentration, which occurs after C. Visiting with children
chemotherapy and radiation. D. Semi-Fowler’s position
B. It interferes with folic acid metabolism, which is 27.The nurse is assessing a client with a radiation implant and
essential for synthesis of nucleoproteins required by observes that the implant has been dislodged. The nurse
rapidly dividing cells cannot immediately locate the implant. The first nursing action
C. It suppresses the bone marrow that produces the is to
formed elements of the blood. A. Notify the radiation safety team.
D. It decreases the level of amino acid necessary for B. Call the physician and bar all visitors from the room.
tumor growth C. Pick up the source with a foot-long applicator.
18.A client with testicular cancer asks the nurse, “Which is the D. Search for the implant in the bed covers and place it
most common type of cancer in men?” The nurse replies that in a lead container.
it’s prostate cancer. Which type of cancer causes the most 28.A client who reports increasingly difficulty swallowing,
deaths in men? weight loss, and fatigue is diagnosed with esophageal cancer.
A. Prostate cancer Because this client has difficulty swallowing, the nurse should
B. Lung cancer assign highest priority to:
C. Breast cancer A. helping the client cope with body image changes.
D. Colon cancer B. ensuring adequate nutrition
19.A women loses most of her hair as a result of cancer C. maintaining a patent airway
chemotherapy. The nurse understands that which of the D. preventing injury
following is true about alopecia? 29.A client with a nagging cough makes an appointment to see
A. New hair will be gray the physician after reading that this symptom is one of the
B. Avoid use of wigs seven warning signs of cancer. What is another warning sign of
C. The hair loss is temporary cancer?
D. Pre- chemo hair will return A. Persistent nausea
20.The client is advised by the physician to have B. Rash
mammography screening annually. Measures to improve C. Indigestion
adherence with mammography screening include: D. Chronic ache or pain
A. Making sure that the individual barriers to screening 30.The nurse is instructing a premenopausal woman about
are minimized. breast self-examination. The nurse should tell the client to do
B. Emphasizing that mammography screening can her self-examination:
prevent breast cancer. A. at the end of her menstrual cycle
C. Emphasizing that mammography screening is a B. on the same day each month
low-cost approach to cancer prevention. C. on the 1st day of the menstrual cycle
D. Informing the client that she is at high risk for breast D. immediately after her menstrual period
cancer and needs to follow the physician's 31.The nurse understands that that Hodgkin’s disease is
recommendation. suspected when a client presents with a painless, swollen
21.A client receiving external radiation to the left thorax to lymph node. Hodgkin's disease typically affects people in which
treat lung cancer has a nursing diagnosis of Risk for impaired age group?
skin integrity. Which intervention should be part of this client’s A. Children (ages 6 to 12 years).
care plan? B. Teenagers (ages 13 to 20 years).
A. Avoiding using soap on the irritated areas. C. Young adults (ages 21 to 40 years).
B. Applying powder to the irritated areas daily after D. Older adults (ages 41 to 50 years).
bathing 32.A client with testicular cancer is scheduled for a right
C. Wearing a lead apron during direct contact with the orchiectomy. The day before surgery, the client tells the nurse
client that he is concerned about the effect that losing a testicle will
D. Removing thoracic skin markings each radiation have on his manhood. Which of the following facts about
treatment orchiectomy should form the basis for the nurse's response?
22.A priority nursing diagnosis for a client receiving A. Testosterone levels are increased.
chemotherapy would be: B. Sexual drive and libido are unchanged.
A. Excess Fluid Volume. C. Sperm count increases in the remaining testicle.
B. Impaired Physical Mobility. D. Secondary sexual characteristics change.
C. Risk for Infection. 33.The incidence and risk of cancer increase when smoking is
D. Disturbed Body Image. combined with
A. asbestos exposure and alcohol consumption

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 B. ultraviolet radiation exposure and alcohol C. Increase the ventilator’s respiratory rate to 20
consumption breaths/minute
C. asbestos exposure and ultraviolet radiation exposure D. Administer antihypertensives as ordered.
D. alcohol consumption and a diet high in nitrite-cured 43.BJ a client who fell from a ladder has been pronounced
foods brain dead. All of the following will be seen except:
34.Alvin with a spinal cord injury (SCI) complains about a A. Decerebrate posturing
severe throbbing headache that suddenly started a short time B. Dilated nonreactive pupils
ago. Assessment of the patient reveals increased blood C. Deep tendon reflexes
pressure (168/94) and decreased heart rate (48/minute), D. Absent corneal reflex
diaphoresis, and flushing of the face and neck. What action 44.BJ a client with head trauma develops a urine output of 300
should you take first? ml/hr, dry skin, and dry mucous membranes. Which of the
A. Administer the ordered acetaminophen (Tylenol). following nursing interventions is the most appropriate to
B. Check the Foley tubing for kinks or obstruction. perform initially?
C. Adjust the temperature in the patient’s room. A. Evaluate urine specific gravity
D. Notify the physician about the change in status. B. Anticipate treatment for renal failure
35.You are helping Alvin a patient with an SCI to establish a C. Provide emollients to the skin to prevent breakdown
bladder-retraining program. All of the strategies may stimulate D. Slow down the IV fluids and notify the physician
the patient to void except: 45.Which of the following position describes decerebrate
A. Stroke the patient’s inner thigh. posturing?
B. Pull on the patient’s pubic hair. A. Internal rotation and adduction of arms with flexion of
C. Initiate intermittent straight catheterization. elbows, wrists, and fingers
D. Pour warm water over the perineum. B. Back hunched over, rigid flexion of all four extremities
36.Madam Arlene a patient with multiple sclerosis tells the with supination of arms and plantar flexion of the feet
nursing assistant that after physical therapy she is too tired to C. Supination of arms, dorsiflexion of feet
take a bath. What is your priority nursing diagnosis at this D. Back arched; rigid extension of all four extremities.
time? 46.BJ a client with cervical spine injury at the level of C5.
A. Fatigue related to disease state Which of the following conditions would the nurse anticipate
B. Activity Intolerance due to generalized weakness during the acute phase?
C. Impaired Physical Mobility related to neuromuscular A. Absent corneal reflex
impairment B. Decerebrate posturing
D. Self-care Deficit related to fatigue and neuromuscular C. Movement of only the right or left half of the body
weakness D. The need for mechanical ventilation
37.You are providing nursing care for Alvin a patient with GBS. 47.A 20-year-old client BJ who fell approximately 30’ is
What observation would you report immediately? unresponsive and breathless. A cervical spine injury is
A. Complaints of numbness and tingling suspected. How should the first-responder open the client’s
B. Facial weakness and difficulty speaking airway for rescue breathing?
C. Rapid heart rate of 102 beats per minute A. By inserting a nasopharyngeal airway
D. Shallow respirations and decreased breath sounds B. By inserting a oropharyngeal airway
38.Madam Arlene a patient who had a stroke needs to be fed. C. By performing a jaw-thrust maneuver
What instruction should you give to the nursing assistant who D. By performing the head-tilt, chin-lift maneuver
will feed the patient? 48.BJ a 30-year-old male client was admitted to the
A. Position the patient sitting up in bed before you feed progressive care unit with a C5 fracture from a motorcycle
her. accident. Which of the following assessments would take
B. Check the patient’s vital signs. priority?
C. Feed the patient quickly because there are three more A. Bladder distension
waiting. B. Neurological deficit
D. Suction the patient’s secretions between bites of food. C. Pulse ox readings
39.While working in the ICU, you are assigned to care for Alvin D. The client’s feelings about the injury
a patient with a seizure disorder. Which of these nursing 49.Madam Arlene a client with a C6 spinal injury would most
actions is most important if the patient is having a seizure? likely have which of the following symptoms?
A. Place the patient on a non-rebreather mask with the A. Aphasia
oxygen at 15 L/minute. B. Hemiparesis
B. Administer lorazepam (Ativan) 1 mg IV. C. Paraplegia
C. Turn the patient to the side and protect airway. D. Tetraplegia
D. Assess level of consciousness during and immediately 50.Madam Arlene comes into the ER after hitting his head in
after the seizure. an MVA. He’s alert and oriented. Which of the following
40.Madam Arlene recently started on phenytoin (Dilantin) to nursing interventions should be done first?
control simple complex seizures is seen in the outpatient clinic. A. Assess full ROM to determine extent of injuries
Which information obtained during his chart review and B. Call for an immediate chest x-ray
assessment will be of greatest concern? C. Immobilize the client’s head and neck
A. The gums appear enlarged and inflamed. D. Open the airway with the head-tilt chin-lift maneuver
B. The white blood cell count is 2300/mm3. 51.Madam Arlene has signs of increased ICP. Which of the
C. Patient occasionally forgets to take the phenytoin until following is an early indicator of deterioration in the client’s
after lunch. condition?
D. Patient wants to renew his driver’s license in the next A. Widening pulse pressure
month. B. Decrease in the pulse rate
41.Which of the following patients on the rehab unit is most C. Dilated, fixed pupil
likely to develop autonomic dysreflexia? D. Decrease in LOC
A. A client with a brain injury 52.Madam Arlene a client who had a transsphenoidal
B. A client with a herniated nucleus pulposus hypophysectomy should be watched carefully for hemorrhage,
C. A client with a high cervical spine injury which may be shown by which of the following signs?
D. A client with a stroke A. Bloody drainage from the ears
42.BJ 18-year-old client is admitted with a closed head injury B. Frequent swallowing
sustained in a MVA. His intracranial pressure (ICP) shows an C. Guaiac-positive stools
upward trend. Which intervention should the nurse perform D. Hematuria
first? 53.Archie a client with C7 quadriplegia is flushed and anxious
A. Reposition the client to avoid neck flexion and complains of a pounding headache. Which of the following
B. Administer 1 g Mannitol IV as ordered symptoms would also be anticipated?
A. Decreased urine output or oliguria

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 B. Hypertension and bradycardia determines that the family understands the measures to use if
C. Respiratory depression they state that they will:
D. Symptoms of shock A. Place objects in the client’s impaired field of vision
54.Nurse Mike is caring for the client with increased B. Discourage the client from wearing eyeglasses
intracranial pressure. The nurse would note which of the C. Approach the client from the impaired field of vision
following trends in vital signs if the intracranial pressure is D. Remind the client to turn the head to scan the lost
rising? visual field
A. Increasing temperature, increasing pulse, increasing 63.Madam Arlene a nursing student is caring for a client with a
respiration, decreasing blood pressure brain attack (stroke) who is experiencing unilateral neglect.
B. Increasing temperature, decreasing pulse, decreasing The nurse would intervene if the student plans to use which of
respiration, increasing blood pressure the following strategies to help the client adapt to this deficit?
C. Decreasing temperature, decreasing pulse, increasing A. Tells the client to scan the environment
respiration, decreasing blood pressure B. Approaches the client from the unaffected side
D. Decreasing temperature, increasing pulse, decreasing C. Places the bedside articles on the affected side
respiration, increasing blood pressure D. Moves the commode and chair to the affected side
55.Nurse Mike is positioning the client with increased 64.Nurse Mike is trying to communicate with a client with brain
intracranial pressure. Which of the following positions would attack (stroke) and aphasia. Which of the following actions by
the nurse avoid? the nurse would be least helpful to the client?
A. Head midline A. Speaking to the client at a slower rate
B. Head turned to the side B. Allowing plenty of time for the client to respond
C. Neck in neutral position C. Completing the sentences that the client cannot finish
D. Head of bed elevated 30 to 40 degrees D. Looking directly at the client during attempts at
56.Archie is recovering from a head injury is arousable and speech
participating in care. The nurse determines that the client 65.Madam Leni has experienced an episode of myasthenic
understands measures to prevent elevations in intracranial crisis. The nurse would assess whether the client has
pressure if the nurse observes the client doing which of the precipitating factors such as:
following activities? A. Getting too little exercise
A. Blowing the nose B. Taking excess medication
B. Isometric exercise C. Omitting doses of medication
C. Coughing vigorously D. Increasing intake of fatty foods
D. Exhaling during repositioning 66.Jessie a client with Parkinson’s disease has a nursing
57.Archie has clear fluid leaking from the nose following a diagnosis of Falls, Risk for related to an abnormal gait
basilar skull fracture. The nurse assesses that this is documented in the nursing care plan. The nurse assesses the
cerebrospinal fluid if the fluid: client, expecting to observe which type of gait?
A. Is clear and tests negative for glucose A. Unsteady and staggering
B. Is grossly bloody in appearance and has a pH of 6 B. Shuffling and propulsive
C. Clumps together on the dressing and has a pH of 7 C. Broad-based and waddling
D. Separates into concentric rings and tests positive for D. Accelerating with walking on the toes
glucose 67.Nurse Mike has given instructions to Jessie a client with
58.Nurse Mike is planning to institute seizure precautions for a Parkinson’s disease about maintaining mobility. The nurse
client who is being admitted from the emergency department. determines that the client understands the directions if the
Which of the following measures would the nurse avoid in client states that he or she will:
planning for the client’s safety? A. Sit in soft, deep chair
A. Padding the side rails of the bed B. Exercise in the evening to combat fatigue
B. Putting a padded tongue blade at the head of the bed C. Rock back and forth to start movement with
C. Placing an airway, oxygen, and suction equipment at bradykinesia
the bedside D. Buy clothes with many buttons to maintain finger
D. Having intravenous equipment ready for insertion of dexterity
an intravenous catheter 68.Nurse Mike has given suggestions to the client with
59.Nurse Mike is caring for the client who begins to experience trigeminal neuralgia about strategies to minimize episodes of
seizure activity while in bed. Which of the following actions by pain. The nurse determines that the client needs reinforcement
the nurse would be contradicted? of information if the client makes which of the following
A. Loosening restrictive clothing statements?
B. Restraining the client’s limbs A. “I will wash my face with cotton pads.”
C. Removing the pillow and raising padded side rails B. “I’ll have to start chewing on the unaffected side.”
D. Positioning the client to the side, if possible, with the C. “I’ll try to eat my food either very warm or very cold.”
head flexed forward D. “I should rinse my mouth sometimes if tooth-brushing
60.Nurse Mike is assigned to care for a client with complete is painful”
right-sided hemiparesis. The nurse plans care knowing that in 69.Nurse Mike has given a client with Bell’s palsy instructions
this condition: on preserving muscle tone in the face and preventing
A. The client has complete bilateral paralysis of the arms denervation. The nurse determines that the client need
and legs additional information if the client states that he or she will:
B. The client has weakness on the right side of the body, A. Expose the face to cold and drafts
including the face and tongue B. Massage the face with a gentle upward motion
C. The client has the ability to move the right arm but is C. Perform facial exercise
able to walk independently D. Wrinkle the forehead, blow out the cheeks, and
D. The client has lost the ability to ambulate whistle
independently but is able to feed and bathe self 70.Madam Leni is admitted in the hospital with a diagnosis of
without assistance Guillain-Barré syndrome. The nurse inquires during the nursing
61.Madam Arlene a client with brain attack (stroke) has admission interview if the client has a history of :
residual dysphagia. When a diet order is initiated, the nurse A. Seizures or trauma to the brain
avoids doing which of the following? B. Meningitis during the last 5 years
A. Giving the client thin liquids C. Back injury or trauma to the spinal chord
B. Thickening liquids to the consistency of oatmeal D. Respiratory or gastrointestinal infection during the
C. Placing food on the unaffected side of the mouth previous month
D. Allowing plenty of time for chewing and swallowing 71.Madam Leni a client with Guillain-Barré syndrome has
62.Nurse Mike has instructed the family of a client with brain ascending paralysis and is intubated and receiving mechanical
attack (stroke) who has homonymous hemianopsia about ventilation. Which of the following strategies would the nurse
measures to help the client overcome the deficit. The nurse

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incorporate in the plan of care to help the client cope with this 80.Archie an unconscious client with multiple injuries arrives in
illness? an emergency department. Which nursing intervention receives
A. Giving client full control over care decisions and the highest priority?
restricting visitors A. Establishing an airway
B. Providing positive feedback and encouraging active B. Replacing blood loss
range of motion C. Stopping bleeding from open wounds
C. Providing information, giving positive feedback, and D. Checking for neck fracture
encouraging relaxation 81.Kieth is at risk for increased intracranial pressure. Which of
D. Providing intravenously administered sedatives, the following would be the priority for the nurse to monitor?
reducing distractions, and limiting visitors A. Unequal pupil size
72.Madam Leni has impairment of cranial nerve II. Specific to B. Decreasing systolic pressure
this impairment, the nurse would plan to do which of the C. Tachycardia
following to ensure client’s safety? D. Decreasing body temperature
A. Speaking loudly to the client 82.Which of the following respiratory patterns indicates
B. Test the temperature of the shower water increasing intracranial pressure in the brain stem?
C. Check the temperature of the food on the dietary tray A. Slow, irregular respirations
D. Provide a clear path for ambulation without obstacle B. Rapid, shallow respirations
73.Madam Leni has a neurological deficit involving he limbic C. Asymmetric chest excursion
system. Specific to this type of deficit, the nurse would D. Nasal flaring
document which of the following information related to the 83.Which of the following nursing interventions is appropriate
client’s behavior? for a client with increased intracranial pressure of 21 mmHg?
A. Is disoriented to person, place, and time A. Give the client warm blanket
B. Affect is flat, with periods of emotional lability B. Administer low-dose barbiturates
C. Cannot recall what was eaten for breakfast today C. Encourage client to hyperventilate
D. Demonstrates inability to add and subtract; does not D. Restrict fluids
know who is the president 84.Kieth has signs of increased intracranial pressure. Which of
74.Nurse Mike is planning to test the function of the trigeminal the following is an early indicator of deterioration in the client’s
nerve (cranial nerve V). the nurse would gather which of the condition?
following items to perform the test? A. Widening pulse pressure
A. Tuning fork and audiometer B. Decreased in the pulse rate
B. Snellen chart, opthalmoscope C. Dilated, fixed pupils
C. Flashlight, pupil size chart or millimeter ruler D. Decrease in level of consciousness
D. Safety pin, hot and cold water in test tubes, cotton 85.Nurse Mike obtains a specimen of clear nasal drainage from
wisp a client with a head injury. Which of the following tests
75.Nurse Mike is testing the coordinated functioning of cranial differentiates mucus from cerebrospinal fluid?
nerves III, IV, and VI. To do this correctly, the nurse would test A. pH
the: B. Specific gravity
A. Corneal reflex C. Glucose
B. Pupil response to light D. Microorganisms
C. Six cardinal fields of gaze 86.Kieth has sustained an increase in intracranial pressure of
D. Pupil response to light and accommodation 20 mmHg. Which client position would be most appropriate?
76.Nurse Mike is admitting a client with Guillain-Barré A. Elevate head of bed 30-45 degrees
syndrome to the nursing unit. The client has an ascending B. Trendelenburg’s position
paralysis to the level of the waist. Knowing the complications C. Left Sims position
of the disorder, the nurse brings which of the following items D. Head elevated on 2 pillows
into the client’s room? 87.Nurse Mike administers mannitol (Osmitrol) to the client
A. Nebulizer and pulse oximeter with increase intracranial pressure. Which parameter requires
B. Blood pressure cuff and flashlight close monitoring?
C. Flashlight and incentive spirometer A. Muscle relaxation
D. Electrocardiographic monitoring electrodes and B. Intake and output
intubation tray C. Widening pulse pressure
77.Nurse Mike is evaluating the respiratory outcomes for the D. Pupil dilation
client with Guillain-Barré syndrome. The nurse determines that 88.Jessie who is regaining consciousness after a craniotomy
which of the following is the least optimal outcome for the becomes restless and attempts to pull out her I.V. line. Which
client? nursing intervention protects the client without further
A. Spontaneous breathing increasing her intracranial pressure?
B. Oxygen saturation of 98% A. Place her in a jacket restraint
C. Adventitious breath sounds B. Wrap her hands in soft “mitten” restraints
D. Vital capacity within normal range C. Tuck her arms and hands under the draw sheet
78.Nurse Mike is caring for the client in the emergency D. Apply a wrist restraint to each arm
department following a head injury. The client momentarily lost 89.Which activity should nurse Mike encourage the Jessie to
consciousness at the time of the injury and then regained it. avoid when there is a risk for increased intracranial pressure?
The client now has lost consciousness again. The nurse takes A. Deep breathing
quick action, knowing that this is compatible with: B. Turning
A. Concussion C. Coughing
B. Skull fracture D. Passive range-of-motion
C. Subdural hematoma 90.Which of the following will Nurse Mike observe in the client
D. Epidural hematoma in the ictal phase of a generalized tonic-clonic seizure?
79.Nurse Mike has completed discharge instruction for the A. Jerking in 1 extremity that spreads gradually to
client with application of a halo device. The nurse determines adjacent areas
that the client needs further clarification of the instructions if B. Vacant staring and abruptly ceasing all activity
the client stated that he or she will: C. Facial grimaces, patting motions, and lip smacking
A. Use a straw for drinking D. Loss of consciousness, body stiffening, and violent
B. Drive only during the day time muscle contractions
C. Use caution because the device alters balance 91.It is the night before a Jessie is to have a computed
D. Wash the skin daily under the lamb’s wool liner of the tomography (CT) scan of the head without contrast. Which
vest statement by the nurse would be most appropriate?
A. “You must shampoo your hair tonight and remove all
oil and dirt”

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 B. “You may drink fluids until midnight, but after that C. Asking the client to repeat indistinguishable words
drink nothing until the scan is completed” D. Asking the client to speak louder when tired
C. “You will have some hair shaved to attach the small 102.During a scoliosis screening in a college heath center, a
electrode to your scalp” student asks the public health nurse about the consequences
D. “You will need to hold your head very still during the of untreated scoliosis. The nurse would be accurate by
examination” identifying one of the direct complications as:
92.Which clinical manifestation does Nurse Mike expect in the A. osteoporosis of the vertebra
client in the postictal phase of generalized tonic-clonic seizure? B. impingement on pulmonary function
A. Drowsiness C. spontaneous spinal cord injury
B. Inability to move D. pituitary hyposecretion.
C. Paresthesia 103.Gout pain usually occurs in which of the following
D. Hypotension locations?
93.Before breakfast in the morning a client is to have an A. Joints
electroencephalogram (EEG), the client is served soft boiled B. Tendons
egg, toast with butter and marmalade, orange juice, and C. Long bones
coffee. Which of the following should the nurse do? D. Areas of striated muscle
A. Remove all the food 104.A nurse is caring for a client with a diagnosis of gout.
B. Remove the coffee Which of the following laboratory values would the nurse
C. Remove the toast expect to note in the client?
D. Substitute vegetable juice for the orange juice A. Uric acid level of 8 mg/dl
94.Which of the following is an initial sign of Parkinson’s B. Calcium level of 9 mg/dl
disease? C. Phosphorus level of 3 mg / dl
A. Rigidity D. Potassium level of 4 mEq/L
B. Tremor 105.A client with gouty arthritis is prescribed a low-purine diet.
C. Bradikinesia The nurse should instruct this client to avoid:
D. Akinesia A. organ meats
95.Nurse Mike develops a teaching plan for a client newly B. citrus fruits
diagnosed with Parkinson’s disease. Which of the following C. green vegetables
topics that the nurse plans to discuss is the most important? D. fresh fish
A. Maintaining a balanced nutrition 106.A physician tells a client diagnosed with gout that her
B. Enhancing the immune system X-rays are normal. Which of the following responses would be
C. Maintaining a safe environment the most appropriate when the client asks if she still has gout?
D. Engaging in diversional activities A. No, you’re cured
96.Nurse Mike observes the client’s upper arm tremors B. Yes, X-rays are unreliable
disappear as he unbuttons his shirt. Which statement best C. Yes, X-rays are normal in the early stages of gout
guides the nurse’s analysis of this observation about the D. Yes, X-ray changes are only seen with acute attacks.
client’s tremors? 107.A client has been diagnosed with gout and wants to know
A. The tremors are probably psychological and can be why colchicine is used in the treatment of gout. Which of the
controlled at will following actions of colchicine explains why it’s effective for
B. The tremors sometimes disappear with purposeful gout?
and voluntary movements A. Replaces estrogen
C. The tremors disappear when the client’s attention is B. Decreases infection
diverted by some activity C. Decreases inflammation
D. There is no explanation for this observation, it is D. Decreases bone demineralization
probably a chance occurrence 108.A client with gout is encouraged to increase fluid intake.
97.Which goal is the most realistic and appropriate for Jessie a Which of the following statements best explains why increased
client diagnosed with Parkinson’s disease? fluids encouraged for gout?
A. To cure the disease A. Fluids decrease inflammation
B. To stop progression of the disease B. Fluids increase calcium absorption
C. To begin preparations for terminal care C. Fluids promote the excretion of uric acid
D. To maintain optimal body function D. Fluids provide a cushion for weakened bones
98.What is the primary goal collaboratively established by 109.A client with gout is receiving indomethacin for pain.
Jessie with Parkinson’s disease, Nurse Mike, and physical Which of the following instructions should be given to a client
therapist Kieth? taking non-steroidal anti-inflammatory drugs?
A. To maintain joint flexibility A. Bleeding isn’t a problem with NSAID’s
B. To build muscle B. Take NSAIDs with food to avoid an upset stomach
C. To improve muscle endurance C. Take NSAIDs on an empty stomach to increase
D. To reduce ataxia absorption
99.Which of the following is not a typical manifestation Jessie a D. Don’t take NSAIDs at bedtime because they may
client with Multiple sclerosis? cause excitement
A. Double vision 110.Which of the following statements explains the main
B. Sudden bursts of energy difference between rheumatoid arthritis and osteoarthritis?
C. Weakness in the extremities A. Osteoarthritis is gender-specific, rheumatoid arthritis
D. Muscle tremors isn’t
100.Jessie has had multiple sclerosis for 15 years and has B. Osteoarthritis is a localized disease, rheumatoid
received various drug therapies. What is the primary reason arthritis is systemic.
why the nurse has found it difficult to evaluate the C. Osteoarthritis is a systemic disease, rheumatoid
effectiveness of the drugs that the client used? arthritis is localized.
A. The client exhibits intolerance to many drugs D. Osteoarthrifis has dislocations and subluxations,
B. The client experiences spontaneous remissions from rheumatoid arthritis doesn’t.
time to time 111.A nurse is caring for a client with osteoarthritis. The nurse
C. The client requires multiple drugs simultaneously performs an assessment, knowing that which of the following
D. The client endures long periods of exacerbation is a clinical manifestation associated with the disorder?
before the illness responds to a particular drug A. Morning stiffness
101.When a Nurse Mike talks to Jessie a client with multiple B. A decreased sedimentation rate
sclerosis who has slurred speech, which nursing intervention is C. Joint pain that diminishes after rest
contraindicated? D. Elevated antinuclear antibody levels
A. Encouraging the client to speak slowly
B. Encouraging the client to speak distinctly

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112.The nurse is developing a teaching plan for a client C. An inflammatory joint disease, with de-generation and
diagnosed with osteoarthritis. To minimize injury to the loss of articular cartilage in synovial joints
osteoarthritic client, the nurse should instruct the client to: D. A noninflammatory joint disease, with de-generation
A. install safety devices in the home and loss of articular cartilage in synovial joints
B. wear comfortable shoes 123.Use of which of the following articles or types of clothing
C. get help when lifting objects would help a client with osteoarthritis perform activities of daily
D. wear protective devices when exercising living at home?
113.A client with possible osteoarthritis is having X-rays A. Zippered clothing
performed on both knees. X-rays of an osteoarthritic joint B. Tied shoes to promote stability
reveal: C. Velcro clothing, slip-on shoes, and rubber grippers
A. Enlargement of the joint space or margin D. Buttoned clothing, slip-on shoes, and rubber grippers
B. Fluid deposition in joint spaces 124.A client with osteoarthritis is refusing to perform her own
C. Osteophyte formation daily care. Which of the following approaches would be most
D. Cartilage growths at weight-bearing joints appropriate to use with this client?
114.The nurse is managing the care of a client with A. Perform the care for the client
osteoarthritis. Appropriate treatment strategies for B. Explain that she needs to maintain complete
osteoarthritis include: independence
A. Administration of narcotics for pain control C. Encourage her to perform as much care as her pain
B. Exercises for painful exacerbations will allow
C. administration of nonsteroidal anti-inflammatory D. Tell her that once she’s completed her care, she’ll
drugs receive a reward
D. Vigorous physical therapy for the joints 125.Clients in the late stages of osteoarthritis often use which
115.A client asks for information about osteoarthritis. Which of of the following terms to describe joint pain?
the following statements about osteoarthritis is correct? A. Grating
A. Osteoarthritis is rarely debilitating B. Dull ache
B. Osteoarthritis is a rare form of arthritis C. Deep aching pain
C. Osteoarthritis is the most common form of arthritis D. Deep aching, relieved with rest
D. Osteoarthritis afflicts people over age 60 126.A nurse has given dietary instructions to a client to
116.Which of the following conditions or actions can cause minimize the risk of osteoporosis. The nurse would evaluate
primary osteoarthritis? that the client understands the recommended dietary changes
A. Overuse of joints, aging, obesity if the client stated he or she should increase intake of which
B. Obesity, diabetes mellitus, aging food?
C. Congenital abnormality, aging, overuse of joints A. rice
D. Diabetes mellitus, congenital abnormality, aging B. Salmon
117.Heberden’s nodes are a common sign of osteoarthritis. C. Sardines
Which of the following statements is correct about this D. Chicken
deformity? 127.The nurse is caring for an elderly female with
A. It appears only in men osteoporosis. When teaching the client, the nurse should
B. It appears on the distal interphalangeal joint include information about which major complication?
C. It appears on the dorsolateral aspect of the A. Bone fracture
interphalangeal joint B. Loss of estrogen
D. It appears on the proximal interphalangeal joint C. Negative calcium balance
118.The treatment for osteoarthritis commonly includes D. Dowager's hump
salicylates. Salicylates can be dangerous in older people 128.For a client with osteoporosis, the nurse should provide
because they can cause which of the following side effects? which dietary instruction?
A. Hearing loss A. "Decrease your intake of red meat."
B. Increased pain in joints B. "Decrease your intake of popcorn, nuts, and seeds."
C. Decreased calcium absorption C. "Eat more fruits to increase your potassium intake."
D. Increased bone demineralization D. "Eat more dairy products to increase your calcium
119.Clients with osteoarthritis may be on bed rest for intake"
prolonged periods. Which of the following nursing interventions 129.A 70-year-old client with a diagnosis of left-sided
would be appropriate for these clients? cerebrovascular accident (CVA) is admitted to the facility. To
A. Encourage coughing and deep breathing, and limit prevent the development of disuse osteoporosis, which of the
fluid intake following objectives is most appropriate?
B. Provide only passive range of motion, and decrease A. Maintaining protein levels
stimulation B. Maintaining vitamin levels
C. Have the client lie as still as possible, and give C. Promoting weight-bearing exercises
adequate pain medicine D. Promoting range-of-motion (ROM) exercises
D. Turn the client every 2 hours, and en- courage 130.A nurse is conducting health screening for osteoporosis.
coughing and deep breathing The nurse would interpret that which of the following client is
120.During the assessment of a client, signs of osteoarthritis at greatest risk of developing this disorder?
are noted. Which of the following assessment findings would A. A 36-year-old man who has asthma
indicate osteoarthritis? B. A 25-year-old woman who jogs
A. Elevated sedimentation rate C. Sedentary 65-year-old woman who smoke cigarettes
B. Multiple subcutaneous nodules D. A 70-year-old man who consumes excess alcohol
C. Asymmetrical joint involvement 131.A home health nurse is planning to teach a client with
D. Signs of inflammation, such as heat, fever, and osteoporosis about home modifications to reduce the risk of
malaise falls. Which of the following recommendations would be
121.Which of the following instructions would be considered unnecessary to include in the teaching plan?
primary prevention of injury from osteoarthritis? A. Use of staircase railings
A. Stay on bed rest B. Use of night lights
B. Avoid physical activity C. Removing wall-to-wall carpeting
C. Perform only repetitive tasks D. Placing handrails in the bathroom
D. Warm up before exercise and avoid repetitive tasks 132.A client seeks treatment in the emergency room for a
122.A client with osteoarthritis wants to know what it is. Client lower leg injury. Deformity of the lower aspect of the leg is
teaching would include which of the following descriptions for visible, and the injured leg appears shorter than the other. The
osteoarthritis? area is painful, swollen, and beginning to become ecchymotic.
A. A systemic inflammatory joint disease The nurse interprets that this client has experienced a
B. A disease involving fusion of the joints in the hands A. Contusion

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 B. Fracture C. Fluid volume deficit
C. Sprain D. fluid volume overload
D. Strain 142.A client with a history of renal calculi caused by gouty
133.The nurse should monitor the client with a pelvic fracture arthritis comes to the outpatient clinic with signs and
receiving an opium derivative, such as morphine, for what symptoms of this disorder. To prevent kidney stone from
common adverse reaction? recurring, the nurse recommends maintaining an alkaline ash
A. Respiratory depression diet to neutralize the urine, On an alkaline-ash diet, the client
B. Diarrhea must suggest which diet?
C. High fever A. eggs
D. Pupil dilation B. plums
134.A client is brought to the emergency department after C. Prune juice
injuring the right arm in a bicycle accident. The orthopedic D. Cranberry juice
surgeon tells the nurse that the client has a greenstick fracture 143.The nurse includes in the discharge teaching of a patient
of the arm. What does this mean? who has had a lithotripsy that the patient should:
A. The fracture line extends through the entire bone A. check for edema of the legs and ankles
substance B. remain on bedrest for 4 weeks
B. The fracture results from an underlying bone disorder C. increase fluid intake to 4000 mL/day
C. Bone fragments are separated at the fracture line D. remains on restricted activity for a week
D. One side of the bone is broken and the other side is 144.A client is to have a cystoscopy to rule out cancer of the
bent bladder. Which of the following signs and symptoms would
135.Which of the following laboratory studies is most relevant indicate that the client has developed a considered normal
to treating a client who has sustained a pelvic fracture? after cystoscopy?
A. Urine myoglobin A. Dizziness
B. Urinalysis B. Chills and fever
C. Type and crossmatch C. Pink-tinged urine
D. Serum ethanol D. severe pain
136.Following a boating accident, a 30-year-old client with 145.The client asks the nurse, “How did I get this urinary tract
multiple fractures is admitted to a semiprivate room in a infection? “The nurse should explain that in most instances,
progressive care unit. The client, who was driving the boat, is cystitis is caused by :
unaware that his girlfriend's 9-year-old son was killed in the A. Congenital strictures in the urethra
accident. The client's parents instruct the nurse to prohibit B. Urinary stasis in the urinary bladder
phone calls and to withhold information about the accident. C. An infection elsewhere in the body
During an assessment of the client, the nurse notices that the D. An ascending infection from the urethra
television is on and the news is starting. It would be most 146.Which of the following symptoms would most likely
appropriate for the nurse to: indicate cystitis?
A. Turn the television off and tell the client it interferes A. Ascites
with the assessment B. Polyuria
B. Allow the client to view the television and deal with C. CVA tenderness
any questions as they come D. suprapubic pain
C. Instruct the client to change the channel to a station 147.Which of the following factors would put the client at
that isn't televising the news increased risk for acute renal failure?
D. Attempt to distract the client from watching the A. History of hypertension
television B. Fluid intake of 2,000 ml/day
137.After surgery to treat a hip fracture, a client returns from C. decrease fluid intake
the post anesthesia care unit to the medical-surgical unit. D. History of diabetes mellitus
Postoperatively, how should the nurse position the client? 148.The client with acute renal failure wants to know the
A. With the affected hip flexed acutely possibility of developing chronic kidney disease. The nurse’s
B. With the leg on the affected side abducted response is based on knowledge that which of the following
C. With the leg on the affected side adducted food most commonly leads to chronic kidney disease?
D. With the affected hip rotated externally A. High in protein diet
138.An X-ray of the left femur shows a fracture that extends B. Low in carbohydrates
through the midshaft of the bone and multiple splintering C. low in potassium
fragments. What is this type of fracture called? D. low in sodium diet
A. Compound fracture 149.When making a home visit to a client with chronic renal
B. Greenstick fracture calculi, which nursing action has the highest priority?
C. Comminuted fracture A. Follow-up on lab values before the visit
D. Impacted fracture B. Observe client findings for the effectiveness of
139.A client is hospitalized for open reduction of a fractured antibiotics
femur. During postoperative assessment, the nurse monitors C. Ask for activities of daily living
for signs and symptoms of fat embolism, which include: D. Ask for 24-hour urine monitoring
A. pallor and coolness of the affected leg 150.The nurse is collecting data from a hospital patient who
B. nausea and vomiting after eating has been admitted with pyelonephritis. He is acutely ill with a
C. hypothermia and bradycardia high fever, chills, nausea, and vomiting. He also has severe
D. restlessness and petechiae pain in the flank area. The primary goal of his treatment is to:
140.The nurse is caring for a client with a distal tibia fracture. A. provide adequate nutrition with a stable body weight
The client has had a closed reduction and application of a toe B. provide adequate hydration with pulse and blood
to groin cast. 36 hours after surgery, the client suddenly pressure within patient norms
becomes confused, short of breath and spikes a temperature C. prevent acute renal failure as its complication
of 103 degrees Fahrenheit. The first assessment the nurse D. prevent further damage to his kidneys that polyuria
should perform is 151.A client has renal colic due to renal calculi. What is the
A. Orientation to time, place and person nurse’s first priority in managing care for this client?
B. Pulse oximetry A. Do not allow the client to ingest fluids
C. Circulation to casted extremity B. Encourage the client to drink at least 500 ml of water
D. Blood pressure each hour.
141.On a nursing assessment the nurse finds the Client with a C. Request the central supply department to send
pounding and slow heart rate. The nurse should continue an supplies for straining urine.
assessment for what problem? D. Administer an opioid analgesic as prescribed.
A. Sodium imbalance
B. Altered renal function

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